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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Alternate routes for children with difficult central venous access
H M Saleh1, A S Abdelaziz, E Hefnawy
1Department of Vascular Surgery, Ain Shams University, Cairo, Egypt. hosamsaleh2003@yahoo.com
Acta Chirurgica Belgica
|December 5, 2008
Summary
Pediatric patients needing long-term IV access can utilize alternate venous routes like the azygos, gonadal, or inferior epigastric veins when standard options are unavailable. These methods provide crucial central venous access for chemotherapy and nutrition.
Area of Science:
- Pediatric Surgery
- Vascular Access
- Interventional Radiology
Background:
- Children undergoing prolonged chemotherapy, parenteral nutrition, or frequent blood draws often exhaust standard central venous access sites.
- Commonly used veins such as axillary, jugular, saphenous, and femoral may become unavailable for cannulation in these complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of utilizing alternative venous pathways for central venous access in pediatric patients.
- To establish the feasibility of using the inferior epigastric vein, gonadal vein, and intercostal veins when conventional routes are occluded.
Main Methods:
- The study involved 30 pediatric patients, with 38 implantable venous access devices (IVADs) inserted.
- Techniques included catheter placement via the inferior epigastric vein (20 patients), right gonadal vein (5 patients), and intercostal veins (5 patients).
- Pre-procedural color Doppler ultrasonography assessed vein patency and confirmed occlusion of standard access sites.
Main Results:
- A total of 38 IVADs were successfully inserted in 30 pediatric patients, with an average age of 1.4 years.
- The average device longevity was 6.5 months, with uncomplicated recovery and successful administration of intravenous therapies.
- Minor complications included infection in two patients and venous thrombosis in two patients.
Conclusions:
- Alternative central venous access routes, including the azygos system, right gonadal vein, and inferior epigastric vein, are critical for pediatric patients with limited conventional options.
- These alternate pathways ensure continued access for essential treatments like chemotherapy and total parenteral nutrition.
- Knowledge of these less common venous access points is vital for managing complex pediatric cases.
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